Intuition, Luck, Opportunity

Sometimes the stars align. A young woman who loved the sun listened to her instincts about some new dark moles on her abdomen. She decided to get her skin checked when she heard about The Skin Cancer Foundation’s Destination Healthy Skin screening program. A power outage almost stopped her, but a series of coincidences and kindnesses got her the help she needed — before it was too late. Her story will inspire you!

There were so many times it could have gone wrong: If her father hadn’t spotted her when she wasn’t wearing makeup. If she hadn’t decided to do some shopping on her lunch break. If the doctor had lingered a little longer at the coffee shop. There are hundreds of seemingly inconsequential decisions that contribute to big moments in our lives, but in the case of Randi A., a 34-year-old woman from Overland Park, Kansas, the combination of luck, timing and intuition that got her into a dermatologist’s office seems particularly fortuitous. It’s not hard to imagine how easily her story could have had a different ending.

A Lifetime of Sunshine

Randi was already aware that her relationship with the sun and tanning could have consequences when, in August 2017, her father brought the issue to her attention. “Is all of that splotchiness from tanning?” he had asked, pointing to a section of skin on her face that was usually covered by makeup.

She knew that it was. Randi had battled bouts of brown, patchy skin for years, usually following exposure to ultraviolet rays. But having a tan — and the occasional sunburn — was just part of life for the Midwesterner, who had spent plenty of time outdoors as a child. “It was small-town, USA,” Randi says, about her Winchester, Kansas, hometown, “with a lot of bike riding, playing outdoors and trips to the swimming pool in the summer.”

She doesn’t, however, remember much sun protection. Her mother may have put sunscreen on her a handful of times, but there were no hats, and no attempt to stay in the shade while the sun beat down. Quite the opposite, really. “My mom used to lay out in the sun with baby oil and iodine,” Randi recalls. “Then, when I was in high school, I started to lay out.”

After a while, she swapped the backyard for a tanning bed. She first began indoor tanning while working at an office that had access to a tanning bed. Things escalated by the time she hit her early 20s, when she began tanning “pretty frequently.” She even worked in tanning salons on and off for a few years, to supplement her full-time job.

Eventually, her use of tanning beds wound down. After a particularly sunny outdoor concert one summer, Randi noticed that the brown spots on her face, also known as melasma, began to get worse. A common skin condition, melasma is usually caused by hormones, sun exposure or a combination of both. This latest bout of the condition gave Randi a small push to incorporate sunscreen into her daily routine and take more notice of her skin in general — including a few dark moles that had cropped up on her abdomen.

“I wanted to go get a skin check to make sure everything was OK, just because I had used tanning beds for a few years, and that’s one of the leading causes of skin cancer.”

“I wanted to go get a skin check to make sure everything was OK, just because I had used tanning beds for a few years, and that’s one of the leading causes of skin cancer,” Randi says. “I had already been shopping around for somewhere to get a screening, but once my Dad brought it up, I thought ‘I just have to commit to go.’ The idea of going to get checked is a good one, but at the same time, committing to a screening is another step entirely.”

Randi had trouble both finding out if her insurance covered annual skin exams, and finding a dermatologist to perform one. One day, not long into her search, she decided to spend her lunch break browsing in a few stores. Without realizing it, Randi had given herself the chance she needed: she spotted The Skin Cancer Foundation’s Destination Healthy Skin RV sitting in the parking lot of the shopping center.

New Yorkers lined up for information, sunscreen samples and screenings in Union Square Plaza.

Perfect, Randi thought. She approached the vehicle but realized her luck had run out quickly. Screenings for the day were already over, and the RV was prepping to leave. “The man working the event handed me some pamphlets and sunscreen samples, and we got to talking about sun exposure, my history as a tanner and skin cancer,” Randi says. “He told me, ‘It’s one of those things that’s so treatable if you catch it in time, but if it gets past a certain point…’”

There was still hope for Randi to get an exam, though. There would be one more Destination Healthy Skin event in Overland Park before the RV was off to Indianapolis. Randi would have to get to the Deer Creek Golf Club between 11 AM and 2 PM on Sunday, or she would miss her chance.

The Elusive Exam

The morning of August 20, 2017, Randi was anxious. “I was nervous before I left my house, just wondering, ‘What happens if they find something?’” she says. “It was all that last-minute panic that goes through your brain, but I told myself I had to go.”

Randi arrived at the event and found that, in spite of her determination, the universe had a different plan. She approached the RV to find a large group of people gathered around it, waiting. The vehicle had lost power — something that had never happened before — and screenings couldn’t be performed. The event coordinators were trying to find somewhere else the volunteer doctor could examine people, but there were no suitable rooms in the golf club. “It felt like everything was working against me,” Randi says. “I was just thinking, What the heck, man.”

While Randi contemplated her bad luck, the doctor who had volunteered her time to perform free screenings was returning from a brief coffee break with her nurse. “We showed up that day and they told us about the outage,” says Nahid E. Shahrooz, MD, a dermatologist at Associated Plastic Surgeons in Leawood, Kansas, who had already performed screenings for three previous events in the area. “We waited around a while and went to grab some coffee, since we were hoping they would be able to fix it. They worked hard, but, unfortunately, were unsuccessful.”

Dr. Shahrooz and her nurse, Chris Cooper, volunteered in Kansas City.

Generator issues aside, Kansas City nearly missed out on Destination Healthy Skin altogether — the program was only in the area thanks to the generosity of a family that had been affected by melanoma. All In For Skin is the family’s annual golf and poker tournament that raises money to support local youth affected by melanoma. The RV was in the location of the golf tournament taking place that day.

Randi, who had no interest in golf, soon spotted Dr. Shahrooz by the RV in her white coat. She struck up a conversation with the doctor and her nurse, Chris Cooper. As they talked, Randi expressed her disappointment that she wouldn’t be able to get a screening and even pointed out a few moles on her arm to ask what Dr. Shahrooz thought of them.

“Everyone was telling her, ‘Sorry, we can’t do screenings,’” Dr. Shahrooz says. “And Chris actually mentioned that we do these exams in our office. So we told Randi she could come to our office, where we would be happy to do a free screening for her.”

In Burbank, California, patients prepared for a skin exam inside the RV.

Randi maintained her commitment to get checked, wasting no time and calling the office the next day. Within the week, she was finally undergoing her very first skin cancer screening. It was a good thing, too. “When I examined Randi, I found quite a few dysplastic nevi,” says Dr. Shahrooz. Dysplastic nevi, also known as atypical moles, often display some of the same characteristics included in the ABCDEs of melanoma. It can also be hard to tell the difference between an atypical mole and an early melanoma. “She didn’t have any that were very obviously suspicious, but there was one on her thigh that bothered me. It was quite small, but it was much darker than her other moles. I was concerned about it, so I told her she should for sure have this one removed.”

Randi remembered that the mole was new within the year, and she too had noticed the mole’s color. “I googled what kind of moles I should be worried about, but mine didn’t look like any of the ones online,” Randi says. “It was just dark, and I didn’t like it.”

After Dr. Shahrooz explained her recommendations about which moles should be taken off, Randi decided to return to her as a new patient and get them removed. It is important to look for any lesion, no matter what size, that is darker than others. Dr. Shahrooz followed her instincts: she removed the mole on Randi’s thigh first thing, hoping it would not be cancerous.

The pathology report came back a week after Dr. Shahrooz removed the mole. It showed that the lesion was malignant — a superficial spreading melanoma, the most common invasive form of the disease. Randi got the call the day before her 34th birthday. “I had a bad feeling, but it was still shocking to hear,” Randi says. “I knew this was why I was nervous. I had a feeling about this mole since I first noticed it.”

The pathology report showed that the lesion was a malignant melanoma. Randi got the call the day before her 34th birthday. “I had a bad feeling, but it was still shocking to hear.”

Despite the jarring diagnosis, there was some good news. Melanoma is a highly dangerous form of skin cancer, but the one on Randi’s leg was in an early stage and very thin. Even though the prognosis for this type of tumor is very good, time is of the essence. Everyone moved fast. Dr. Shahrooz asked one of the plastic surgeons in her practice to come in right then and talk to Randi about surgery, which was then scheduled as quickly as possible. Today, her scar is around two inches long.

“I was just so glad I got in for a check, and that it was Dr. Shahrooz and Chris who took care of me,” Randi says. “If I hadn’t gone in when I did, it could have been another month, or six months, or who knows how long. Everything worked out the way it was supposed to.”

For Dr. Shahrooz, Randi’s case was an example of how unpredictable skin cancer can be. “I was hoping Randi’s atypical mole would not be melanoma. Sometimes, you just can’t tell 100 percent. Even with the best tools, there’s no way to know for sure. If you’re ever in doubt, remove it.”

If it hadn’t been for Destination Healthy Skin stopping that day in Kansas, Randi’s perseverance and Dr. Shahrooz’s follow-up, Randi may have never gotten that melanoma removed. Intuition, luck and opportunity may have aligned just enough to save her life.

Moving Ahead

After she had the melanoma removed, Randi went in to have eight more atypical moles taken off, since they are associated with an increased risk of melanoma. Thankfully, they were not cancerous. She now sees Dr. Shahrooz for a skin exam every three months. She also has a few things she wishes she could say to her younger self. “Embrace your skin the way it is, and take care of it!” she says, adding that she’s taken significant steps to start protecting herself from the sun. “I wear sunscreen under my makeup every day now,” Randi says. “I carry a parasol around. I bought UV-blocking driving gloves for my commute to work.”

Randi is not only making personal changes. She spoke to her boss and helped organize an on-site skin cancer screening for all employees at her workplace. Of course, she had a dermatologist in mind for the task. Dr. Shahrooz was all in, and visited the company in April 2018 to perform dozens of skin exams.

“I try to make time to do free screenings because I’m so passionate about preventive medicine and early detection,” Dr. Shahrooz says. “One person still dies of melanoma every hour. No one should die of melanoma. If all of us do these screenings more often, we can save lives. The best part of being a doctor is to make a difference in people’s lives.”

Ali Venosa is communications coordinator for The Skin Cancer Foundation.

This article was first published in the 2018 issue of The Skin Cancer Foundation Journal.